ABIM’s Attempt to Hide Its Dark Skeletons

Kurt Eichenwald’s recent piece in Newsweek, “The Civil War on Doctors“, was a ray of light. Finally, a major media outlet writing about “doctors charging that the American Board of Internal Medicine has forced them to do meaningless work to fatten the board’s bloated coffers.” Finally!

The author asserts that ABIM has made the exams that physicians periodically take to maintain their certification harder in hopes of failing more physicians, who then must re-take the test and pay more fees to ABIM. This is untrue and not supported by data. The author says pass rates are steadily declining, but in fact they rise and fall over the years and vary across disciplines. In total, 96% of physicians who ABIM certifies passed an exam to maintain their certification.

ABIM is essentially accusing Eichenwald with a ” liar, liar, pants on fire”, however, it does not change the facts he represented. The pass rates, according to ABIM’s own website support Eichenwald’s claim regarding recertification rates. Yet, ABIM has the audacity to claim a “In total, 96% of physicians who ABIM certifies passed an exam to maintain their certification.” How exactly is it a total of 96%? Is this combining first year certification and MOC? Where does the 96% come from?

There are a few key underlying issues that really need to be brought to light when discussing the “exam”. Although there is a basic “blueprint” for the exam, there is no way of knowing whether ABIM is truly following the percentage. “ABIM examinations are confidential, in addition to being protected by federal copyright and trade secret laws.” The Internal Medicine exam covers: Cardiovascular Disease, Gastroenterology, Pulmonary Disease, Infectious Disease, Rheumatology/Orthopedics, Endocrinology, Diabetes and Metabolism, Medical Oncology, Hematology. Nephrology/Urology, Allergy/Immunology, Psychiatry, Dermatology, Obstetrics/Gynecology, Ophthalmology, Otorhinolaryngology and finally, Other.

An exam where the failure rates have been going down considerable in the last few years — at an unprecedented rate — all the while the exam itself, lacks any transparency. Physicians who take the exam, have no ability to retrieve the answers to the questions they answered wrong. Even review courses that are offered all over the country have been targeted by ABIM and sued and labeled physicians as “cheating”.

There is a enormous fear factor that ABIM uses against physicians and of course, ABIM profits from this fear in more ways than one. ABIM has been able to keep their “customer loyalty” with fear. What physician wants to risk losing their entire career? Sure, when you send physicians emails laced with obscure threats which imply “if you don’t sign up, you will be listed in our database as “not meeting requirements”, what else can physicians do? Interestingly enough, a study done by Lea Dunn and JoAndrea Hoegg in the Journal of Consumer Research shows that fear is a motivating factor in marketing. What a branding strategy ABIM! I wonder how many physicians are physically repulsed and afraid of ABIM? Probably not a small number.

The author asserts that ABIM has a monopoly on certifying internists, but in reality, internists have a choice among certifying boards that certify physicians in internal medicine and its subspecialties.

Thankfully, as of February 2015, most physicians and internists have a choice now that Dr. Paul Tierstein has created the National Board of Physicians and Surgeons (NBPAS). Nonetheless, ABIM conveniently leaves out key information regarding the Internal Medicine certification. If you are a physician who holds multiple certifications, your ABIM Internal Medicine (IM)certification is subject to scrutiny. According to ABIM, if an ABIM diplomate is maintaining an Adolescent Medicine, Hospice and Palliative Medicine, Sleep Medicine or Sports Medicine certification, then he or she will need to also maintain a valid, underlying certification in either Internal Medicine or another ABIM subspecialty. This also applies to the following – Require a current, valid Cardiovascular Disease Certificate:

Advanced Heart Failure & Transplant Cardiology

Clinical Cardiac Electrophysiology

Interventional Cardiology

Require a current, valid Gastroenterology Certificate:

Transplant Hepatology

Translation: If you don’t recertify with ABIM, your subspecialty certification is not valid. Where does ABIM get the justification to require some physicians to “maintain” their IM certification in order to keep their sub-specialty certification while other physicians do not need to maintain it?

The author also presents an untrue and misleading interpretation of information from ABIM and ABIM Foundation’s tax returns. His reporting reflects a poor understanding of that information and a highly selective presentation of information designed to prove his faulty premises.

Seriously? It doesn’t require a law degree or a CPA for that matter to review a the ABIM_2012 IRS 990. Take a look for yourself.

Page 1, Line 12 b Total Revenue: $55,625,925

Page 9, Line 1 g (A) Total Test Revenue: $53,912,942

How is that a “faulty premise”?

Finally, the author failed to disclose that his wife is an internist.

Let’s talk about ABIM disclosures. How many disclosures did ABIM make to physicians paying to take the exam, what the money was being used for? Was the $2.3 million luxury condo disclosed? Did ABIM, disclose dual board memberships on academic journals promoting MOC? Did ABIM disclose the relationships with pharmaceutical companies that created the MOC modules?

It is offensive to implicate Eichenwald as some how “biased”, simply because his spouse is a physician What exactly is ABIM trying to say? Is it, if you have a loved one who is a physician, your opinion does not count?

ABIM recognizes serious challenges in developing a relevant, meaningful Maintenance of Certification program that identifies physicians whose knowledge has been reassessed and who have shown that they have kept up to date with evolving medical information. That is why, last month, we announced immediate changes to the requirements for maintaining certification and the way ABIM works. We are sincere in our desire to work openly with the internal medicine community to rethink the ways in which ABIM serves physicians and the public.

MOC is essentially a re-credentialing process that is, in my opinion, unnecessary, expensive and burdensome for a practicing physician. Especially since practicing physicians have already undergone medical school to obtain the medical doctorate, passed all the qualifying exams in order to enter residency, and many have passed the initial board certification exam in the specialty they have trained in. They obviously are demonstrating continuing competency with daily practice and lifelong learning by following their state medical board CME requirements. State medical boards, not ABMS/ABIM determines the amount of CME hours required.

To clarify, MOC is not continuing medical education. MOC is a corporate program requiring explicit payments to recognized CME as “MOC CREDITS”. While this CME may be similar to any continuing education requirement that exists for most all professions, in order to keep up with the changing nature of medicine and technology, the cost is separate and significant, and goes directly to the ABMS boards as an additional and unnecessary cost of healthcare. In reality, MOC is meaningless. These organizations have been spending millions of dollars in an attempt to create an exam that to date, has not been proven at all useful. It is a waste of time, money and resources. Forcing physicians to be caught in a beta test model of various exams and modules is a redundant effort which benefits only ABIM.

This is no different than what organized crime syndicates are doing – except this is legalized. How many other “Boards” have jumped on this moneytrain – or better yet – the backs of toiling physicians who are just trying to keep afloat? They say that bullying is an epidemic in the U.S. – well, its not just in the schools. PUNKS.